Staggered start times, break times, dismissal times. Alternate shifts, alternate days. Math class in church cemeteries. No playing catch or hugging, however hula hooping permitted.
More than three out of four children and youth worldwide — 1.37 billion students — were affected by COVID-19 school closures as countries, fearful children would be infected and propagate the virus, emptied classrooms in March.
More than a dozen countries have since fully or partially re-opened schools. As Canada’s provinces scramble to bring students back to something resembling “near-normal” learning, there are lessons to be learned from what went well — and not so well.
Ontario’s education minister promises next week to unveil a new plan to reopen schools. “The premier and the government continue to be focused on a safe, conventional, day-to-day return to school,” education minister Stephen Lecee said Thursday. “Maybe a new conventional where kids still can go to school five days a week.”
Toronto’s SickKids hospital is also due to update its guidance after last month laying out a plan that advised not requiring children to wear masks or maintain social distancing while at play.
Alberta has vowed to open schools at “near-normal” levels for K-to-12 students come September. British Columbia is also aiming for a full return of primary and middle school students, rather than a hybrid model of part-time inclass, part-time virtual learning, that few parents want.
There’s near universal agreement that continued closures would be disastrous. Children’s hospitals are already seeing a spike in mental health consults and vulnerable kids are bearing the physical and emotional brunt of prolonged shutdowns.
What can the experiences in other countries teach us? “We have to be super-careful,” cautions Arthur Caplan, founding head of the division of ethics at NYU School of Medicine in New York City. “People keep saying, ‘we can learn from other countries, we can learn from their experiences.’ This thing’s been around since March. What are we, July? It’s four months of experience (with COVID-19). I wouldn’t call that solid yet.”
Certainly, there are risks of restarting class, of picking up where we left off, says Amy Greer. But they’re hard to quantify. The risks depend on the amount of community transmission happening in a given area, and public health’s ability to rapidly test, contact trace and stamp out flare-ups.
Different countries and different school districts have taken different approaches. And not all children are equal. It’s still hard to get a feel for the true impact on transmission dynamics, “because most of what we know seems to be coming from media reports, which is less than ideal,” Greer, Canada Research Chair in population disease modelling said this week at a virtual panel discussion hosted by the Global Research Collaboration for Infectious Disease Prevention.
When do kids become more like adults in their ability to get, and spread the virus? The evidence so far suggests that, unlike the flu and other respiratory bugs, children don’t appear to be super-spreaders, that kids aren’t to blame for COVID-19 surges or spikes. A recent commentary in the journal Pediatrics suggests schools should be allowed to remain open, even during periods of COVID-19 spread.
Denmark became the first country in Europe to reopen its schools in April after early evidence suggested children usually don’t become very ill with COVID. Primary school children were the first to return. “Micro-groups” of 12 students arrive at staggered times, “eat lunch separately, stay in their own zones in the playground and are taught by one teacher,” according to a recent academic summary of school reopenings. Children wash their hands hourly, but staff and students aren’t requested to wear masks. Classes are taught inside one day, moved outside the next, including church graveyards where, as Bloomberg reported, fifth graders have calculated ages based on birth and death dates engraved on gravestones. School reopenings in Denmark have so far not led to any obvious increase in the growth rate of COVID-19. “You cannot see any negative effects from the reopening of school,” Dr. Peter Andersen of the Danish Serum Institute told Reuters.
Norway shuttered its schools in early March and then began bringing students back in April, with kindergarten students first, then grades 1 through 4. Older children returned in May. The primary school students washed their desks daily, class sizes were capped at 15 and, like Denmark, reopening didn’t reignite the epidemic.
Germany began gradually reopening a limited number of high schools in May. Students sat in small (eight to 10) class sizes at designated desks separated by tape. Researchers shared the results of a study of more than 2,000 high school students and teachers from 13 schools in Saxony: Five millimetres of blood were withdrawn from an arm vein and examined for antibodies to the SARS-CoV-2 virus. Of the 2,045 blood samples examined, antibodies were detected in only 12, “which corresponds to a share well below one per cent,” professor Reinhard Berner of the University Hospital Carl Gustav Carus said in a statement. “This means that a silent, symptom-free infection has so far occurred less frequently than we had suspected among the students and teachers we examined.”
Israel, by contrast, offers a cautionary lesson. After a complete lockdown of all schools in March, Israel began limited reopening of kindergarten to grade 12 students in small groups in early May, and a couple weeks later, on May 17, flung open the entire school system while simultaneously lifting restrictions on bars, restaurants and gatherings.
“What happened next was entirely predictable,” Hagai Levine, an epidemiologist at the Braun School of Public Health and Community Medicine of the Hebrew University of Jerusalem told the Daily Beast. Ten days later, there was a major COVID-19 outbreak at a high school in Jerusalem; 260 students, staff, relatives and friends were infected. The outbreak “displayed mass COVID-19 transmission upon school reopening,” according to one study that blamed crowded classes of 35 to 38 that made physical distancing impossible, and an unbearable heat wave that led Health Minister Yuli Edelstein to temporarily lift mask rules for students. As of mid-July, 125 schools and 258 kindergartens had been closed because of COVID-19 infections, reports the Washington Post.
Sweden was one of few countries that kept day care and primary schools open. According to a report by Public Health Agency of Sweden researchers, closures and reopenings did not have an impact on the number of lab-confirmed cases of SARS-CoV-2 in primary school kids (ages seven to 15), indicating that children likely play a small role in propagating the infection.
Another report, this one by researchers at the Institut Pasteur in France, found no significant child-to-child, or child-to-teacher transmission in primary schools. Researchers found just three probable cases of COVID-19 among 510 students in three different schools in Crépy-en-Valois before schools shut for the February vacation, and then for the lockdown. According to the researchers, children ages six to 11 appear less contagious than teenagers.
Still, sending children back to school isn’t going to be zero-risk, Greer said, and Caplan worries about older teachers, older janitors, older bus drivers and older support personnel. Another worry is the notion of a one-size fits all approach. “A big private school with sprawling grounds and high school kids, I’m pretty sure can pull off distancing,” Caplan said. “An inner-city poor school with small rooms maybe needs to think about getting into a different space.”
Nor are all kids alike, he said. “What puts your kid at risk? If it’s your high school kid and they vape, is that a problem? If it’s your little kid and they have asthma, do you have to think twice? If it’s a kid who has had some kind of genetic disease, like sickle cell or something, does it matter?
“You don’t want to say, ‘okay, school’s open. Let’s go.”